Current Concepts in Otitis Media

Otitis media continues to be a common and disabling problem which has become, in recent years, a fertile area for research. Based on studies in animals and humans, otitis media is classified into four groups: acute purulent otitis media (POM), serous otitis media (SOM), and mucoid or secretory otitis media (MOM). Together, these are referred to as otitis media with effusion (OME). The types can overlap and evolve into another type to become chronic otitis media and mastoiditis, characterized by the presence of granulation tissue or cholesteatoma. The biochemistry, microbiology, and pathology as well as clinical features of the disease are discussed

Neurodegeneration and sensorimotor function

Sensorimotor integration is an essential function for both motor control and learning. Over recent decades, a growing body of evidence has emerged in support of the role of altered sensorimotor integration in the pathophysiology of various neurological conditions and movement disorders, particularly bradykinesia, tremor, and dystonia. However, the various causes and mechanisms underlying altered sensorimotor integration in movement disorders are still not entirely understood. The lack of complete insight into the pathophysiological role of altered sensorimotor integration in movement disorders is certainly due to the heterogeneity of movement disorders as well as to the variable occurrence of neurodegenerative phenomena, even in idiopathic movement disorders, which contribute to pathophysiology in a complex and often not easily interpretable way. Clarifying the possible relationship between neurodegenerative phenomena and sensorimotor deficits in movement disorders and other neurological conditions may guide the development of a more detailed disease prognosis and lead, perhaps, to the implementation of novel and individualized therapeutic interventions

β‐Ionone: Its Occurrence and Biological Function and Metabolic Engineering

β‐Ionone is a natural plant volatile compound, and it is the 9,10 and 9’,10’ cleavage prod-uct of β‐carotene by the carotenoid cleavage dioxygenase. β‐Ionone is widely distributed in flowers, fruits, and vegetables. β‐Ionone and other apocarotenoids comprise flavors, aromas, pigments, growth regulators, and defense compounds; serve as ecological cues; have roles as insect attractants or repellants, and have antibacterial and fungicidal properties. In recent years, β‐ionone has also received increased attention from the biomedical community for its potential as an anticancer treatment and for other human health benefits. However, β‐ionone is typically produced at relatively low levels in plants. Thus, expressing plant biosynthetic pathway genes in microbial hosts and engineering the metabolic pathway/host to increase metabolite production is an appealing alternative. In the present review, we discuss β‐ionone occurrence, the biological activities of β‐ionone, empha-sizing insect attractant/repellant activities, and the current strategies and achievements used to re-construct enzyme pathways in microorganisms in an effort to to attain higher amounts of the de-sired β‐ionone

Accreditation procedure for Trichinella spp. Detection in slaughterhouses: The experience of an internal laboratory in Italy

Trichinellosis is a severe foodborne zoonotic disease due to the consumption of undercooked meat containing Trichinella spp. larvae. According to Commission Regulation (EU) No 1375/2015, domestic pigs, farmed wild boar, and horses must be tested for the presence of the parasite in the muscles as part of post-mortem examination. In this study, the accreditation procedure and the maintenance of the certificate for internal laboratory attached to a slaughterhouse are described. The main advantages of such accreditation are represented by the possibility to obtain fast results in order to process carcasses quickly, whereas the difficulties for the technician are linked to performing proficiency testing and following training courses. This program can be considered particularly useful for surveillance and food safety purposes

Abnormal direction of internal auditory canal and vestibulocochlear nerve

Several internal auditory canal (IAC) anomalies have been reported.To our knowledge, only one case with anabnormal direction of the IAC has been reported in an infant with Pierre Robin syndrome. In this paper, wepresent the first report of two non-syndromic cases with abnormal IAC direction.</p

What every doctor should know about drug safety in patients with chronic kidney disease

Drug safety is a very relevant issue when dealing with patients with chronic kidney disease (CKD) who need vascular access procedures and interventions. Drug dosage adjustments are needed for patients with acute or chronic kidney disease. In CKD patients, the estimated glomerular filtration rate is used to guide dose adjustments. Determining the influence of renal replacement therapies on drug dosage adjustment is also very important. Safety issues for the following drugs used for situations related to vascular access are reported: anticoagulants and antiplatelet agents, antibiotics, antimicrobials for catheter lock therapy, thrombolytics, local anesthetics, and painkillers. General principles of the interactions of drugs in CKD are also reported

Hoffa’s fat pad thickness: a measurement method with sagittal MRI sequences

Background: Hoffa’s fat pad is a structure located within the fibrous joint capsule of the knee joint, but outside the synovial cavity. It plays an important biomechanical and metabolic role in knee joint, reducing the impact of forces generated by loading and producing cytokines. Changes in its size can induce modifications in the knee homeostasis. However, a great variability exists regarding its measurements. This work aims to evaluate the reliability of a measurement method of Hoffa’s fat pad dimensions through MRI. Methods: 3T sagittal IW 2D TSE fat-suppressed MRI sequences, taken from the OAI (Osteoarthritis initiative) database, of 191 male and female patients, aged between 40 and 80&nbsp;years, were analysed; a manual measurement of the thickness of Hoffa’s fat pad of each subject was then performed by two different readers. The interobserver reliability and intraobserver reliability of the measurements were described by coefficient of variation (CV), Pearson correlation and Bland–Altman plots. Results: All statistical analyses have shown that not significant intra- or interobservers differences were evident (intraobserver CV % for the first observer was 2.17% for the right knee and 2.24% for the left knee, while for the second observer 2.31% for the right knee and 2.24% for the left knee; linear correlation was for the first observer r = 0.96 for the right knee and r = 0.96 for the left knee, while for the second observer r = 0.97 for the right knee and r = 0.96 for the left knee; in addition, the interobserver CV % was 1.25% for the right knee and 1.21% for the left knee and a high interobserver linear correlation was found: r = 0.97 for the right knee and r = 0.96 for the left knee). All results suggest that this manual measurement method of Hoffa’s fat pad thickness can be performed with satisfactory intra- and interobserver reliability. Conclusions: Hoffa’s fat pad thickness can be measured, using sagittal MRI images, with this manual method that represents, for his high reliability, an effective means for the study of this anatomical structure

17.2 Cardiac resynchronization: Multicenter experience with a new coronary sinus lead

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Short-term plasticity of the motor cortex compensates for bradykinesia in Parkinson's disease

Patients with Parkinson's disease (PD) show impaired short-term potentiation (STP) mechanisms in the primary motor cortex (M1). However, the role played by this neurophysiological abnormality in bradykinesia pathophysiology is unknown. In this study, we used a multimodal neuromodulation approach to test whether defective STP contributes to bradykinesia. We evaluated STP by measuring motor-evoked potential facilitation during 5 Hz-repetitive transcranial magnetic stimulation (rTMS) and assessed repetitive finger tapping movements through kinematic techniques. Also, we used transcranial alternating current stimulation (tACS) to drive M1 oscillations and experimentally modulate bradykinesia. STP was assessed during tACS delivered at beta (β) and gamma (γ) frequency, and during sham-tACS. Data were compared to those recorded in a group of healthy subjects. In PD, we found that STP was impaired during sham- and γ-tACS, while it was restored during β-tACS. Importantly, the degree of STP impairment was associated with the severity of movement slowness and amplitude reduction. Moreover, β-tACS-related improvements in STP were linked to changes in movement slowness and intracortical GABA-A-ergic inhibition during stimulation, as assessed by short-interval intracortical inhibition (SICI). Patients with prominent STP amelioration had greater SICI reduction (cortical disinhibition) and less slowness worsening during β-tACS. Dopaminergic medications did not modify β-tACS effects. These data demonstrate that abnormal STP processes are involved in bradykinesia pathophysiology and return to normal levels when β oscillations increase. STP changes are likely mediated by modifications in GABA-A-ergic intracortical circuits and may represent a compensatory mechanism against β-induced bradykinesia in PD

Sexual developmental disorders in pediatrics

Disorders of sex development (DSD) are a heterogeneous group of pathologies that result in an alteration in sex determination or differentiation. DSD are estimated to affect 1: 4,500 newborns and according to the 2006 Chicago Consensus classification, DSD can be divided into three categories: those with a 46 XX karyotype, those with a 46 XY karyotype and those relating to sex chromosomes. It is crucial to correctly identify the pathology already in the first days of life to direct the patient and his family to the best path of care. For this reason, the role of the pediatrician is fundamental in the correct identification of the clinical picture and in supporting the family during the long process that involves the management of these patients. To make a diagnosis, it is necessary to follow a path led by a multidisciplinary team that includes several steps such as the execution of the genetic analysis, the evaluation with diagnostic imaging methods and laboratory evaluations. The therapeutic management, on the other hand, is still very complex even if in recent years we have moved from an attitude of early gender reassignment to an approach of watchful waiting to let the patient choose when she/he is mature enough to do so, which gender she/he feels to belong. It should not be forgotten that throughout this process the pediatrician must be both supportive and clinically active in the management of the child and his family